I spent four minutes in total listening to an orthopaedic surgeon at a workshop on Learning from Excellence at a national patient safety conference. I did not find out the surgeon’s name but here is what I did discover:-

He had received some positive feedback in writing from a patient who had felt anxious about her planned surgery. The feedback thanked the surgeon for his calm, caring demeanour and the patience he showed in answering the patient’s questions and allaying her fears. As a result of receiving this feedback I discovered that the surgeon felt happy and proud. As a result of our conversation, in which he spoke and I listened, the surgeon had decided to go back to the team he works in to suggest that they start gathering data specific to how well prepared patients feel for surgery – he was thinking about a likert scale with space for a qualitative comment – he was thinking that the importance of preparation in terms of the patient experience could be overlooked and that by focusing on this area a range of improvements were possible.

We had been asked in our pair to think about:-

A story of excellence in care

How the story made the story teller feel

What could be done to create more of the moments shared in the story

The Learning from Excellence Philosophy

Safety in healthcare has traditionally focused on avoiding harm by learning from error. This approach may miss opportunities to learn from excellent practice. Excellence in healthcare is highly prevalent, but there is no formal system to capture it. We tend to regard excellence as something to gratefully accept, rather than something to study and understand. Our preoccupation with avoiding error and harm in healthcare has resulted in the rise of rules and rigidity, which in turn has cultivated a culture of fear and stifled innovation. It is time to redress the balance. We believe that studying excellence in healthcare can create new opportunities for learning and improving resilience and staff morale’

Does pride helps us to deal with shame and release compassion?

‘Your mind is like a garden, whatever you focus on grows’

MatthieuRicard, Bhuddist Monk

The fear referred to in the Learning from Excellence philosophy drives the dominant narrative in health care – the rules and rigidity increase in relation to the fear which often manifests in the individual as guilt (I have done something bad), internal shame (I am bad) or both.

In their book the Archaeology of Mind: Neuroevolutionary Origins of Human EmotionJaakPansepp and Lucy Biven throw light on the neural sources of our human values and basic emotional feelings. The ‘primary processes’ which are located in deep areas of the brain include fear, rage, grief and care. The secondary process in which we make sense of these primal feelings and begin to integrate our experiences are empathy, trust, pride, blame, guilt, and shame.

Primary processing in medicine is complex – when culture and practice is healthy care is clearly central but when things go wrong fear and panic can set in and cultures can become toxic. In these circumstances secondary processing in healthcare is dominated by blame, guilt and shame – which may help to explain why the system is experienced by many as institutionally defensive.

Learning from Excellence fosters pride in accomplishment and is grounded by noticing and giving voice to appreciation–thismay help practitioners to come to terms with guilt and shame.Paul Gilbert OBE,the founder of theCompassionate Mind foundation has concluded from research that the number one block to the flow of compassion (self to self, self to other, other to self) is shame.

So, here is what I am thinking now….

by generating pride and making appreciation explicit could Learning from Excellence help to balance the health care system by enabling the flow of compassion?